Cocaine-associated chest pain

Background

• Cocaine is a catalyst for CAD & up to 6% of cocaine related CP develop an MI, however, a 9-12 hour period of ECG's and serial troponins can be safe. Of the 334 pts studied, if both were negative, no deaths from CV events occurred at 30 days. 4 pts did have non-fatal MI's but were using coc at the time (NEJM 2/03).

Epidemiology

1) causes vasculitis

2) 6% incidence of AMI w/ cocaine CP

3) Cocaine assoc c 24x risk of MI

Diagnosis

1) 1- 3hrs onset from last use

-if >3 hrs = lower risk of MI

2) Most with characterislnic pain

3) Dyspnea, diaploresis, and nausea

4) Most have nl vitals

Workup

= nl CP w/o (see disposition)

Treatment

1) Benzos

2) Labetalol?

• Theoretical contra-indication B-blocker 2nd to unopposed alpha

Disposition

May discharge after: 9-12 hour period of ECG's and serial troponins.

If both are negative.

(NEJM 2/03; n=334; outcome of zero events at 30dys if no more cocaine)

Risk Stratification

Lower:

- also low risk if ecg normal and without ischemic changes

- cocaine can however cause AMI, dilated cardiomyopathy,/ chf

Source

10/07 DONALDSON (adapted from Lampe, Mistry)